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mesothelioma surgery

New Surgical Procedures for Cancer Patients Limit the Danger of Complications

mesothelioma treatmentRecently, I noticed an article published by Cure Magazine that talked about the different innovations that are allowing cancer surgery patients to recover more quickly with fewer complications.

What are the standard surgical procedures?
Before I get into highlights of the article, I think it’s important to delve into the types of surgery that doctors may use to treat non-small cell lung cancer. The National Cancer Institute lists the following four types:

1. Wedge resection removes the tumor, as well as some of the healthy tissue that surrounds it.
2. Lobectomy cuts out an entire section of the affected lung.
3. Pneumonectomy gets rid of an entire lung.
4. A sleeve resection removes part of the bronchus, which is the airway that connects the windpipe to the lung.

Surgery for small cell lung cancer may be more complicated because this form of the disease often affects both lungs at the same time. The lymph nodes may be abnormal, as well. In either case, patients may need to undergo additional treatments with radiation or chemotherapy.

Regardless of the type of surgery that doctors use, there are always risks for post-operative complications. These include pain, blood clots, nerve damage and infections. However, scientists are trying to improve surgical procedures to curb the danger.

New tools are helping doctors
Traditionally, doctors operate on cancer through open surgery, which means that they make incisions that are large enough to provide visual and physical access to the tumor. The risks associated with open surgery can be reduced if the incisions are smaller.

To that end, doctors can use a variety of tools to reach malignant tissues while causing minimal damage to the healthy areas. These may include laparascopes, which are tiny telescopic cameras that let doctors see inside patients, and surgical robots that doctors can control remotely. Also, a procedure known as natural orifice translumenal endoscopic surgery, or NOTES, allows clinicians to insert tools through a patient’s body via flexible endoscope, which is a tube that creates a passageway when it goes through the mouth.

“Minimally invasive procedures now represent about half of all cancer surgeries we do,” Eric Grogan, M.D., told Cure Magazine. “Ten years ago, 95 percent would have been traditional open surgeries. The minimally invasive approaches have changed the risks-benefits ratio a bit because it has slightly reduced the risk of the operation.”

Although these innovations reduce tissue damage, they still carry the risk of blood clots and infection. In order to tackle the former, more doctors are prescribing blood-thinners to be taken after surgery.

Infection control is a little bit more complicated and requires more work. This includes the prescription of antibiotics, blood glucose monitoring, controlled-warming of a patient’s body after surgery and careful administration of anesthesia during an operation, which is important for the prevention of pneumonia.

Asbestos exposure is a real public health threat. Every year, asbestos-induced lung cancer claims the lives of about 4,800 individuals in the U.S., as estimated by the Environmental Working Group. That number is expected to increase over the next 10 years or so.

Fortunately, it looks like surgical options are becoming safer for patients. However, let’s not let that diminish the importance of curbing asbestos use and production.

Families of Mesothelioma Patients Face Tough Choices When Weighing Surgical Options

doctor with patientWhen you’re taking care of a loved one with malignant pleural mesothelioma (MPM), each decision is difficult. How can I keep them comfortable? Where can we get medical consultations or legal advice? Should we think about the full round of treatments or stay more conservative? At Kazan, McClain, Lyons, Greenwood and Harley, we’ve spent more than three decades helping people make tough but informed choices.

One of the more difficult decisions out there is whether to pursue surgery for mesothelioma. Some doctors are adamant that radical operations (like the extrapleural pneumonectomy, or EPP) will not cure the disease, while others emphasize that such procedures do provide pain relief and may extend survival time.

For those weighing the idea of surgery for MPM, here is a quick summary of some of the arguments for and against. This is by no means a complete list. To make a fully informed decision, talk with your oncologist and/or surgical specialist before making any decisions.

How surgery can help

Most public health agencies agree that, even for a disease as virulent as mesothelioma, surgery has several notable benefits. The first is that it can lengthen a loved one’s life by months, if not years. The National Cancer Institute (NCI) estimates that patients who receive surgery for MPM live an average of 16 months beyond their diagnosis.

Of course, survival time depends on several things. First, the earlier a patient’s disease is caught, the longer they may be expected to live. In a study published in the Journal of Thoracic and Cardiovascular Surgery, researchers determined that patients with Stage I or II mesothelioma had much better odds of surviving two, three or even four years, compared to those with Stages III or IV.

The same report noted that pleurectomy/decortication and EPP are the two operations associated with the highest likelihood of prolonged survival.

Another benefit of surgery is that it often provides comfort for mesothelioma patients. In fact, the NCI currently categorizes all MPM procedures as palliative, meaning they do not cure the disease but they may ease chest pressure and make breathing easier.

There are a number of operations for MPM, some more extensive than others. A thoracentesis, in which fluid is drained from the pleura, is one of the simplest and most common procedures. More radical is the pleurectomy/decortication, which involves the removal of one lung and as much tumor mass as possible. Finally, the EPP is the most radical, removing as it does a lung, the lung and heart linings, and most of the diaphragm. Each surgery may provide pain relief or extend survival.

How surgery can be counterproductive

Sadly, not all operations for MPM increase a patient’s lifespan – or, if they do, it may be by a matter of weeks or months only. In the British Journal of Surgery, a pair of surgeons summarized the difficulties by pointing to Lionel Shriver’s memoir of dealing with MPM, titled So Much for That:

She plots the course, from diagnosis to death, of a woman with abdominal mesothelioma in present-day America. Fourteen months after being given a one-year expectation of life, her doctors run out of options and the family runs out of money. The oncologist comforts her bankrupt husband saying “we’ve probably extended her life a good three months.” The bitter irony of “good” strikes the spouse, but seems lost on the doctor.

Such situations are not the standard, but they do happen. It is best to know that while surgery can (and often does) help, it also may not.

Consider whether doctors believe an operation will make your loved one more comfortable. Talk to them, take some time to think about it and, in the end, do what you think is best.

Mesothelioma Treatment by Stage

surgery tableSome treatments come into play in nearly all cases of malignant pleural mesothelioma (MPM), while others are used much more sparingly. If you or a loved one has been diagnosed with the disease, you’re almost certainly curious to know: Which treatments will be available? Does the regimen vary by stage of illness? Will I have a choice of treatments?

These are important questions, and at Kazan, McClain, Lyons, Greenwood and Harley, we encourage you to ask them. Your doctors and legal counsel will be able to fill you in on the treatments available for each stage of mesothelioma.

MPM is measured in four stages, with the first being considered local, and the other three categorized as advanced. If mesothelioma is caught in its early stage, it is usually by accident. However, a history of asbestos exposure can help contribute to early diagnosis, since doctors know that the mineral is the sole proven cause of mesothelioma.

Many MPM patients receive chemotherapy and radiation. These modes of treatment help shrink tumors and slow malignant growth. Surgeries, on the other hand, are more dependent on MPM stage.

As a rule of thumb, the less invasive a procedure is, the more often it is used. For example, fluid draining is a very common minor surgery for MPM, one that nearly all patients will undergo. All draining surgeries end in the suffix –centesis (e.g. thoracentesis, paracentesis and pericardiocentesis). In each case, surgeons insert a needle into the chest cavity to drain built-up fluid and relieve pressure.

Surgical resections (that is, removal of tissue) are also quite common, but the extent depends on disease stage. In debulking and pleurectomy/decortication, doctors remove as much tumor mass as they can while leaving the organs mostly intact. The operations are usually utilized for stages I, II and sometimes III.

A more radical surgery, known as extrapleural pneumonectomy (EPP), comes into play when MPM is more advanced, as in stages II and III. In an EPP, surgeons take out the diaphragm muscle, the chest cavity lining, the sac surrounding the heart and one lung.

Stage IV mesothelioma is typically considered “unresectable,” meaning it is so advanced and a patient is so weak that surgery is not an option.

Two things to keep in mind:

1. There is no one-size-fits-all treatment for MPM. Every case of mesothelioma is different, and doctors take many wellness factors into account before recommending certain procedures.

2. All treatments for MPM, surgical or otherwise, are considered palliative. This is because, for now, none is curative. However, treatments ease the tumor burden and improve comfort level, two very important benefits for people living with mesothelioma.

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